Abstract
Abstract Post-extraction alveolar ridge resorption is a common sequela when missing mandibular molar spaces are not managed in a timely fashion. The situation becomes more complicated in patients who seek orthodontic treatment if closure of the edentulous space is the major objective in order to avoid prosthetic rehabilitation. In the present article, two cases are reported, in which different bone augmentation graft materials were used and treatment duration and post-orthodontic alveolar ridge characteristics were compared. A regional acceleratory phenomenon after the grafting procedure facilitated uneventful orthodontic space closure. The status of the investing alveolar bone was compared using post-treatment cone-beam computed tomography. Both autogenous bone graft and allograft ridge augmentation procedures aided in successful molar protraction through the resorbed mandibular alveolar ridge, as well as preventing periodontal attachment loss.
Highlights
Bony alveolar defects in adults pose a challenge for orthodontists when closing a mandibular first molar extraction site
The treatment plan for an atrophic ridge should consider re-opening of the missing molar space to allow restoration by prosthetic means
Eleven months after the start of orthodontic treat ment, the lower right mandibular edentulous ridge was expanded via periodontally accelerated osteo genic orthodontics (PAOO) and freeze-dried bone allografts (FDBA) grafted to remove the alveolar ridge barrier and enable space closure
Summary
Bony alveolar defects in adults pose a challenge for orthodontists when closing a mandibular first molar extraction site. Tooth movement is more difficult in adults than in adolescents because of reduced cell activity, higher bone density, a narrower and atrophic edentulous ridge, and possible periodontal tissue involvement.[2] The treatment plan for an atrophic ridge should consider re-opening of the missing molar space to. The treatment goals were: (1) to improve the protrusive facial appearance through retraction of the upper and lower anterior teeth, (2) reduce the lower anterior facial height and autorotate the mandible to strengthen the chin projection, (3) correct the dental midlines, (4) close the remaining lower right edentulous space and plan future 35 × 37 bridge fabrication for the lower left area, (5) achieve bilateral Class I canine relationships. The treatment plan involved extracting the upper second premolars, closing the lower right first molar extraction site and distalising the lower anterior teeth to resolve the space problem and lip protrusion. Two mini-screws were inserted into the infrazygomatic crest to support anterior retraction and vertical control of the posterior teeth (Fig. 1)
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